Provider Demographics
NPI:1134676000
Name:PROFLEX PHYSICAL THERAPY OF MARYLAND, LLC
Entity Type:Organization
Organization Name:PROFLEX PHYSICAL THERAPY OF MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-932-4785
Mailing Address - Street 1:10 SAINT PATRICKS DR
Mailing Address - Street 2:401
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4527
Mailing Address - Country:US
Mailing Address - Phone:301-870-7366
Mailing Address - Fax:301-870-6717
Practice Address - Street 1:4701 RANDOLPH RD
Practice Address - Street 2:105
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2257
Practice Address - Country:US
Practice Address - Phone:301-990-9599
Practice Address - Fax:240-221-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation